Children Reap Benefits From One Man's Desire to Help

Perhaps it is fate, destiny putting the right person in the right place at the right time.

More likely, it is the result of thorough training, hard work and a passionate approach to providing care for those who seem to need it most.

Regardless of the confluence of forces making it a reality, Jerry L. Lanier, DDS, is making a difference in the lives of thousands of children. Through his two clinics in the Los Angeles area and his far-reaching program to provide care for underprivileged children, Lanier is fulfilling his long-held desire to offer the possibility of better oral health to children who otherwise might not have it.

Lanier, 43, was one of 11 children born to uneducated parents in a backwoods North Carolina town. He attended Meharry Dental School in Nashville, Tenn., on a scholarship and originally planned to specialize in oral surgery following his 1983 graduation. But four years of working on youngsters at a children's dental clinic changed his mind.

"While working at a clinic in a New Orleans housing project, I saw so many kids who needed treatment and couldn't afford to go elsewhere," says Lanier, a member of the Los Angeles Dental Society. "I realized there was a lot of suffering going on, and it made me realize this career was something special."

After working for the Public Health Service in New Orleans, Lanier moved to Los Angeles in 1991 and worked in a variety of dental offices. Finally, he struck out on his own.

"I was riding around and saw an abandoned dental office for lease in a low-income neighborhood," Lanier says. "I couldn't afford a lot, this place was affordable, and I saw kids up and down the streets, so I didn't need to do any demographic study. I just looked for the strollers."

Lanier wanted to give his new clinic a catchy name, one that clearly communicated a high level of care and commitment to his young patients.

"I wanted to give the clinic a name that explained our entire mission," Lanier says. "With a three-word name, Kids Dental Kare, I wanted people to know we are there to treat kids, and the care we provide was something special, just for kids."

Soon after the clinic opened, it was February, Children's Dental Health Month. Lanier decided to make a concerted effort to establish relations with the mostly Hispanic and Armenian community surrounding the clinic.

"I wanted within the month to go to every school in the area," Lanier says. "I gave away toothbrushes in every classroom and spent almost every morning going from one school to the next to meet with school nurses. They are on the front line and see the kids with toothaches and mouths in terrible condition."

Lanier's registered dental assistant developed a skit to present to the schoolchildren. Now, according to Lanier, many schools are requesting presentations.

"She goes to the school in her RDA uniform and uses a hand puppet to demonstrate proper brushing technique while singing a song in Spanish to the children," he says. "Sometimes I take my guitar along and play, and the kids love being involved."

After five years of work at the clinic, Lanier and his associates have treated more than 12,000 children. A year ago, while gearing up for a new office opening, Lanier wanted to make his young patients feel more at ease. Today, the 40 patients he and his associates treat daily have a lot of entertainment choices.

"The new office has a movie room with surround sound, a video room with game stations, and quite a large waiting area with lots of play toys," he said. "We even have a TV in each of the 17 operatories with intraoral cameras."

Lanier also operates a mobile screening van that stops at schools, health fairs, and anywhere in the area where there is a group of 20 or more children. He and his associates -- general dentist Michael Rice, DDS; and pediatric dentists, Michael Vert, DDS, and Scott Fishman, DDS -- are busy: They do at least 50 screening events a year, for a total of about 10,000 screenings annually. At the screenings, they give away toothbrushes, balloons and dental education kits. He accepts no donations from outside sources to support his efforts.

For Children's Dental Health Month 1999, Lanier plans to participate in four health fairs with area physicians, the Red Cross and other agencies, and to visit up to two schools a day to do screenings, for a total of about 50 screenings and presentations during the month.

"We'll also give out up to 50,000 toothbrushes and work to educate a lot of parents during that time," he said. "I believe one of the things lacking most in children's dentistry is education. Most of the time parents don't know anything about caring for primary teeth, so we want to give them a little education. Our focus during the month is to educate parents and raise awareness."

Discipline is the Key to Investment Highs and Lows

Following a disciplined approach is one of the first rules of successful investing, particularly with stocks. Two time-tested investment strategies, based on stocks in the Dow Jones Industrial Average, have shown that discipline can pay off over time. These strategies are known as Top 10 and Low Five.

Under the Top 10 strategy, an investor buys the 10 highest-yielding common stocks in the Dow Jones and holds them for 12 months. After 12 months, any stocks that are no longer among the Top 10 are sold, and any that are new to the list are bought.

With the Low Five approach, an investor purchases the five lowest-priced of the 10 highest-yielding Dow Jones common stocks and holds them for 12 months, after which time the investor makes readjustments so that he or she continues to hold the five lowest-priced of the 10 highest-yielding Dow Jones stocks.

Here are four reasons that these strategies appeal to investors:

1. The 30 companies in the Dow Jones are large, well-known and the "blue chip" names.

2. When buying the highest-yielding stocks, investors are in effect purchasing issues that may be out of favor. The high yield can mean the share prices are depressed and have potential for appreciation.

3. The yields may provide support for the stock prices in down markets because stocks offering moderate dividend yields may perform better during weak markets than stocks that do not pay dividends.

4. The strategies may be carried out either by individual investors or, for sometimes as little as $1,000, through professionally selected fixed portfolios of securities offered by major financial firms.

(Please note that the Dow Jones Industrial Average and Dow Jones are the property of Dow Jones & Company, Inc., which is unaffiliated with and has not participated in any way in the creation of the Top 10 and Low Five strategies or any products based on these.)

Marios Gregoriou is associate vice president and financial adviser with Morgan Stanley Dean Witter in Sacramento. He can be reached at (800) 755-8041. Information in this article was obtained from sources considered to be reliable. This article does not constitute investment advice. Consult an investment adviser before making investment decisions.

Singin' the Managed Care Blues

Just as managed care has come to dominate medicine and is making greater inroads in dentistry, HMOs' biggest musical critic has segued into the dental arena with his latest tune, "Mastoid Sally."

Dr. Sam Bierstock and his band of "preferred music providers" have added a dental ditty to their repertoire of managed care blues tunes. They've recently recorded the CD single "Mastoid Sally." The parody is a follow-up to the band's CD, "Minimal Service CPT 99211," which also bemoans the confusion and red tape often associated with HMOs.

"Mastoid Sally" is a foot-tapping, teeth-grinding tribute to dentists sung to the tune of "Mustang Sally." The band's keyboard player, Dr. Jimmy Pantel, is a dentist.

"We wanted to do a song specifically for our colleagues in dentistry and otolaryngology," Bierstock says. "Not everyone realizes that dentistry has many concerns about managed care just as the rest of the health care industry does."

With managed care issues dominating headlines and emerging as a top concern for millions of Americans, Bierstock, a former eye surgeon, says he recorded the song after it was repeatedly requested at performances and on his web site. He says people enjoy the humorous twist to the song, which describes Sally's ongoing battle with bruxism and TMD. In the song, the dentist admonishes:

Mastoid Sally, guess you better slow that chewing down.
Mastoid Sally, guess you better slow that chewing down.
You been grinding in your sleep girl.
Guess I better do a bonding or a crown.

Bierstock's satire has not escaped the attention of politicians who are hotly debating health care issues on Capitol Hill. Rep. Greg Ganske, R-Iowa, who co-authored the Patient's Bill of Rights, distributed a copy of Bierstock's "Minimal Service" CD to every member of Congress, noting in an attached letter that "a little levity always helps when you are discussing the subject of health care."

Bierstock agrees and has used this premise to embark on a national tour that has taken him and his band across the country to medical conventions and corporate events to spread his message.

"I realized the medical profession was in serious need of a good laugh," Bierstock says. "But we're also trying to help people understand how managed care really works -- or perhaps why
it doesn't."

The "Mastoid Sally" CD single costs $4.25 plus shipping and handling and can be ordered by calling (888) 426-7529 or from Bierstock's web site at www.managedmusic.com.

Original songs from Dr. Sam and the Managed Care Blues Band include:

* "You Picked a Fine Time to Leave Me Blue Shield"

* "You're One Hip Mama ('Cause They Won't Pay for Two)"

* "I'd Love to Kiss You Baby, but I Just Came Across Your Medical Records on the Internet"

* "If You Won't Refuse Treatment We'll Find Someone Who Will"

* "What Now My Glove" (a digital recording)

Managed Care Profits Expected to Rebound in 1999

Higher premiums will return the managed care industry to modest profitability after four tough years, a new study finds, but the market "will ruthlessly weed out under-performing organizations, both not-for-profit and for-profit."

"Beyond HMOs: the Outlook for Managed Care in 2001," published by Corporate Research Group, Inc., forecasts a six-fold increase in industry profits in 1999, to more than $2 billion.

With premiums expected to rise 8 percent to 9 percent in 1999, the report says, the managed care industry can expect revenue growth of 15 percent to reach a projected $173 billion in 1999 revenues. The three largest for-profit managed care companies are United HealthCare, with projected 1998 revenues of about $17 billion; Aetna U.S. Healthcare, projected revenues of $14 billion; and Cigna Life & Health, projected revenues of $12 billion. Kaiser, with revenues of $14.6 billion, is the largest not-for-profit.

Corporate Research Group projects that the managed care industry will finish 1998 with 765 million members, up 8 percent from 1997. Explaining the industry's recent woes, authors Carl Mercurio and Efrem Sigel note, "With HMOs enrolling more elderly, poor and sick members, utilization soared, as did medical costs. ... Profit margins shrank. ... Mega-mergers aimed at improving financial performance often had the opposite effect."

Over the next three years, large managed care companies will continue to prune operations, such as money-losing Medicare or Medicaid plans. "Successful companies will have to meet escalating demands for quality" while controlling costs, and will have to satisfy "multiple constituencies of members, employers, providers, government regulators and investors and creditors," the report says. It predicts that dozens of HMOs will go out of business by 2001.

Pack Your Bags and Make Your CPA Smile

Taking your spouse to Paris for a big dental meeting is one way of writing off your anniversary trip, but it's not the only option.

"Mixing business with pleasure is one of the wisest tax moves you can make," according to Ken Rubin, CPA. "It's fun and easy to structure your vacations so they'll be tax deductible."

The most obvious way to do that is to attend dental continuing education seminars and conventions in places such as Hawaii and Aspen, Rubin says in Facets, August/September 1998. A less obvious method is visiting dental offices at the vacation destination. According to Rubin, if you can establish that the primary purpose of your trip was to visit dental offices, the trip is tax-deductible. Some reasons for visiting the offices could include observations and discussions with dentists about the following items:

* Office design;

* Employment or partnership opportunities;

* Marketing methods;

* Specific dental procedures; and

* Practice management issues.

Rubin strongly recommends getting follow-up letters from the dentists you meet, detailing what was discussed. According to Rubin, you are required to spend at least four hours per day on business-related matters for the entire day to qualify as a business day. If your spouse is employed by your practice, his or her expenses can also be deducted.

Because tax rules related to travel are complicated, Rubin urges dentists to consult their CPAs to help with the tax planning aspects of vacations.

The Mighty Mouse of Marketing

Ten reasons why your business card is your best promotional device:

*It's your first (and sometimes only) piece of promotional material, usually printed as soon as the business starts.

* It is your cheapest advertisement -- a boxful goes a long way.

* It has a wide targeted distribution -- it's mostly handed out face-to-face.

* It sets the business' style and format, which is then echoed on stationery and products.

* It is a basic sales tool, uncomplicated and flexible.

* It is the most frequently used marketing tool for small businesses.

* For many businesses, it generates more patients and referrals than any other form of advertising.

* It is versatile. It is easy, quick and inexpensive to tailor for different markets or purposes.

* It is expected. Business cards are an established business practice that can also serve as an appointment card.

* It creates name recognition, personalizes you, and builds credibility.

The Price Also Rises

New dentists who graduate from dental school and prepare to establish their own practices are on average $81,688 in debt, according to the 1997 Survey of Dental School Seniors produced by the Chicago-based American Association of Dental Schools.

That figure, which includes students from private, public and private/state-related schools, represents a 7.8 percent increase from 1996. In contrast, graduating debt in 1980 was $18,500.

First-year tuition and fees have increased an average of 6 percent each year since the 1989-90 academic year. Average first-year tuition costs for the 1996-97 academic year were $12,771 for residents and $20,709 for students who live out-of-state.

"In order to finance their education, many students are borrowing $20,000 per year or more just to cover the costs of tuition and expenses," says David J. Fulton, DDS, a general dentist in Waukegan, Ill., and president of the Chicago Dental Society. "That makes it incredibly tough to make payments on loans while trying to open an office and establish a dental practice. Some new dentists just don't make it. I would hope that dental schools would step up their efforts to tackle the problem of student debt."

Following are other statistics from the 1997 Survey of Dental School Seniors:

* 13.3 reported no debt.

* 6.8 percent reported debt of $0 to $30,000.

* 10.6 percent reported debt of $30,000 to $50,000.

* 23.6 percent reported debt of $50,000 to $80,000.

* 17.5 percent reported debt of $80,000 to $100,000.

* 18.7 percent reported debt of $100,000 to $150,000.

* 9.5 percent reported debt of more than $150,000.

When the 13.3 percent of students who report no debt are omitted from statistics, the average graduating debt in 1997 rises to $94,182.

Link Between Chlamydia and TMJ is Found

The bacterium Chlamydia trachomatis, which is the leading cause of pelvic inflammatory disease and its resulting infertility, may also cause TMJ dysfunction. This condition affects 10 million Americans, the vast majority of whom are women, according to the National Institutes of Health.

A research team led by oral and maxillofacial surgeon Dr. Charles Henry is the first to identify the presence of Chlamydia trachomatis in human temporomandibular joint tissue, finding the bacterium significantly more prevalent in patients with TMJ dysfunction than in the general population. Henry, assistant professor at the Goldman School of Dental Medicine at Boston University, presented these results at the American Association of Oral and Maxillofacial Surgeons annual meeting in September.

Chlamydia is the most common sexually transmitted bacterium in the United States with an estimated 5 million cases per year. If recognized early, it can be effectively treated with a simple course of antibiotics.

"Our study indicates that chlamydia-induced arthritis may cause TMJ dysfunction and pain in many patients," Henry says.

Since chlamydia is frequently associated with sexually acquired reactive arthritis, its presence in the TMJ tissue suggests that TMJ dysfunction may be a previously unrecognized form of reactive arthritis.

Intervention Helps Teen Athletes Quit Spit

High school baseball players are nearly twice as likely to stop using spit tobacco when dentists or dental hygienists, as well as their teammates, actively intervene than when they don't, a new University of California at San Francisco study has found.

The study, reported at the International Association for Dental Research meeting, found that 27 percent of spit tobacco users stopped using the potentially cancer-causing substance for at least one year when dental health professionals, with the help of teammates, intervened. About 14 percent of the athletes who received no intervention quit using spit tobacco, which includes chewing tobacco and snuff.

The study tracked baseball players at 44 high schools throughout rural California. Dental health professionals intervened at 22 of those schools. There was no intervention at the other 22.

"High school baseball players who participated in a peer-led team discussion of the negative health effects of spit tobacco use, and who received an oral cancer screening exam by a dentist or dental hygienist who pointed out to players sores in their mouths related to spit tobacco use and advised them to stop their tobacco use, were twice as likely to stop using than those players who received nothing," says Margaret Walsh, EdD, UCSF professor of dental public health and the study's principal investigator.

The study's results, Walsh said, show that oral health experts must become more aggressively involved in teaching youths the risk of using spit tobacco.

The study was funded by California's tobacco tax.

Upcoming Meetings 1999

Feb. 3-6 Academy of Laser Dentistry's Sixth Annual Conference and Exhibition, Palm Springs, Calif. (248) 548-7171

Feb. 11-13 East Coast District Dental Society Miami Winter Meeting and Dental Expo, Miami (800) 344-5860 or (305) 667-3647

April 8-11 CDA Scientific Session, Anaheim (916) 443-3382, Ext. 4470

April 13-17 International Dental Show, Cologne, Germany, http://www.koelnmesse.de/ids

April 23-26 UOP/ADA National Conference on Over-the-Counter Dental Drugs and Products, San Francisco (415) 929-6486

April 27-May 1 The American Academy of Oral Medicine Annual Scientific Session (410) 602-8585

April 29-May 1 British Dental Association National Dental Conference, Torquay, England 0971 935 0875

Sept. 16-19 CDA Scientific Session, San Francisco (916) 443-3382, Ext. 4470

Sept. 17-18 Society for Advanced Dentistry Annual Meeting, New Orleans (317) 290-2613

To have a meeting included on this list, please send the information to Upcoming Meetings, CDA Journal, P.O. Box 13749, Sacramento, CA 95853 or fax the information to (916) 443-2943.